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Quality Management Member Liaison

Location: , WV
Job Family: Customer Service
Req #: PS43799-West%20Virginia
Date Posted: Jan 19, 2021

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. 

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.

This position is responsible for member retention by investigating and leading the resolution of member complaints. Serves as a liaison/mediator between member, provider, and Plan. 

 

Responsibilities:

  • Investigates, resolves, and documents member complaints in accordance with policies and state requirements. 
  • Conducts out of office/home visits with members to educate and advise on programs, policy, and benefits. 
  • Investigates and resolves issues regarding members with non-compliant, behavioral, and abusive conduct identified by providers. 
  • Conducts member interviews to ensure that members are informed of their rights and responsibilities. 
  • Assists member as needed, including locating a Primary Care Physician, obtaining medical records, transportation, and completing required forms. 
  • Reviews complaint reports for accuracy and completeness and ensures required reports meet timely filing requirements. 

Qualifications

 


Qualifications:

  • An associate degree from an accredited Institution.
  • 3+ years of experience in a social or health related service-oriented industry; or any combination of education and experience, which would provide an equivalent background.


 Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
 

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